Saturday, August 21, 2010

Nursing Care of the Newborn

Newborns undergo profound physiologic changes at the moment of birth, as they are released from a warm, snug, dark liquid-filed environment that has met all of their basic needs, into a chilly, unbounded, brightly lit, gravity based outside world.
Within minutes after being plunged into this strange environment, a newborn’s body must initiate respirations and accommodate a circulatory system to extrauterine oxygenation.
How well the newborn makes these major adjustments depends on his or her genetic composition, the competency of the recent intrauterine environment, the care received during the labor and birth period, and the care received during the newborn or neonatal period—from birth through the first 28 days of life. (Adele Pillitteri, 2007)
Two thirds of all deaths that occur during the first year of life occur in the neonatal period. More than half occur in the first 24 hours after birth—an indication of how hazardous this time is for an infant. Close observation of a newborn for this indication of distress is essential during this period (National Center for Health Statistics, 2005).

Establish and Maintain a Patent Airway

  1. Never stimulate a baby to cry unless secretions have been drained out.
  2. Mucus should be sustained from a newborn’s mouth by a bulb syringe as soon as the head is delivered.
  3. As soon as an infant is born, he/she should be held for a few seconds with the head lightly lowered for further drainage of secretion.
  4. Suction the newborn properly:
    1. Turn the baby’s head to one side
    2. Suction gently and quickly.
    3. Suction the mouth first before the nose.
    4. Occlude one nostril at a time when testing for airway patency.
    5. Record the first cry.
    6. Maintain appropriate body temperature as chilling will increase the body’s need for oxygen.
    7. Newborn suffers large losses of heat because he is wet at birth, the delivery room is cold he does not have enough adipose tissues and does not know how to shiver.

Keep Newborn Warm

Effects of Cold Stress
  • · Metabolic acidosis
  • · Hypoglycemia
  1. Dry the newborn immediately
  2. Wrap him with a warm blanket but not too tight as not to compromise respiratory effort
  3. Lay infant on his side in a warmed bassinet or place under a droplight
  4. Place a head cap to conserve heat especially if they are in an open crib.
  5. All nursing care should be accomplished quickly as possible to minimize exposure of the infant.
  6. Apgar score—standardized evaluation of the newborn’s condition. Done at one minute after birth to determine the general condition and then at 5 minutes to determine how well the newborn is adjusting to extrauterine life.
    1. Color—all infants appear cyanotic at birth and grow pink with or shortly after the first breath
    2. Heart Rate—auscultation of the newborn’s heart
    3. Reflex irritability—response to a suction catheter or having the soles of their feet slapped.
    4. Muscle tone—newborn hold the extremity tightly flex. They should resist any effort to extend their extremities
    5. Respiratory effort—a mature newborn usually cries spontaneously at about 30 seconds after birth. At one minute, the infant is maintaining regular although rapid respirations.

Immediate Assessment of the Newborn

Appearance: ColorPale, Blue all overPinky body, blue extremitiesPink all over
Pulse: Pulse RateAbsentLess than 100More than 100
Grimace: Reflex IrritabilityNo response to stimulationGrimace/feeble cry when stimulatedSneeze/Coughs/Pulls away when stimulated; good strong cry
Activity: Muscle ToneLimp, flaccidSome flexion of extremitiesWell-flexed extremities
Respiration: BreathingAbsentWeak or irregularGood, strong cry

  • 0-3 points—the baby is serious danger and need immediate resuscitation.
  • 4-6 points—the baby’s condition is guarded and may need more extensive clearing of the airway and supplementary oxygen.
  • 7-10 points—are considered good and in the best possible health.

Vital Statistics/Anthropometric Measurements

Vital Statistic Average Low or Arbitrary Low
Weight 6.5 to 7.5 lbs less than 5.5 lbs.
Length 50cms (20in) 46cms (18in)
Head Circumference 33 to 35 inches.
Chest Circumference 31-33cms or 2cms less than head circumference
Abdominal Circumference 31 to 33 cms

Vital Signs
Vital Sign Immediately At Birth After Birth
Temperature 36.5 to 37.2 Celsius
Pulse 180 beats/minute 120-140 beats/minute ave.
Respiration 80 breaths/minute 30-50 breaths/minute
Blood Pressure 80/46 mmHg 100/50 mmHg (by 10th day)
  1. Proper Identification and Charting
    1. Proper identification of the newborn and footprints must be taken and kept in the chart.
    2. Attach ID bracelet with a number that corresponds to the mother’s hospital number, mother’s full name, sex, date and time of birth.
    3. Inspect for the presence of 2 arteries and 1 vein. Suspect a congenital anomaly if blood vessels are not complete.
    4. Apply triple dye or Betadine for faster healing effect.
    5. This is to cleanse the baby of blood mucus and vernix, and then followed with sponge bath. Dry infant, wrap and keep him warm.
    6. Crede’s Prophylaxis—prophylactic treatment of the newborns eyes against gonorrheal conjunctivitis aka opthalmia neonatarum, which the baby acquires as he passes through the birth canal of the mother who has untreated gonorrhea.

Care of the Umbilical Cord

Give Initial Oil Bath

Administer Eye Care

  • Wipe the face dry.
  • Shade the eyes from light and open one eye at a time by exerting gentle pressure on the upper and lower lids.
  • Apply Erythromycin/Terramycin Opthalmic ointment from the inner to outer canthus of the eye. The antibiotic will eliminate gonorrhea and Chlamydia as well.

Administration of Vitamin K

  1. Vitamin K facilitates production of the clotting factor, thus preventing bleeding.
Method: Aquamephyton 1mg (Phytonadione), a synthetic Vitamin K is injected IM into the lateral aspect of the anterior thigh (vastus lateralis).

Document Birth Record

  1. Accomplish the form properly.
Continue Physical Assessment

Characteristics of a Newborn

1. General Appearance—position and activity
2. Skin
  1. a. Color—ruddy complexion due to increased RBC concentration and decreased subcutaneous fat which makes blood vessels more visible.
    1. Acrocyanosis
    2. Physiologic Jaundice
    3. Texture—slight desquamation for the first 2 to 4 weeks of life
    4. Skin Turgor—good elasticity
    5. Vernix Caseosa—white cream-cheese like that serves as a skin lubricant
    6. Milia—pinpoint size white spots seen on the nose and chin due to obstruction of the sebaceous glands.
    7. Erythema Toxicum—newborn rash. It begins with a papule and eventually to an erythematic appearance.
    8. Lanugo—is the fine downy hair that covers a newborn’s shoulders, back and upper arms. Immature newborns have more lanugo than mature infant.
    9. Birthmarks
      1. Hemangiomas—are vascular tumors of the skin.
        1. Nevus flammeus—muscular purple or dark red lesion. Generally appear on the face and thighs.
        2. Strawberry hemangiomas—elevated areas formed by immature capillaries and endothelial cells.
        3. Cavernous hemangiomas—these are dilated vascular spaces.
        4. Mongolian spots—slate gray patches across the sacrum or buttocks and consist of a collection of pigment cells.
        5. Forceps marks—these are circular or linease contusion matching the rim of the blade forceps on the infant’s cheeks.
3. Head—newborn’s head is disproportionately large
  1. Fontanelles—spaces or opening where the skull bones join
  2. Molding—the part of the infant’s head that engages the cervix. It is molded to fit the cervix contours.
  3. Caput Succedaneum—is edema of the scalp at the presenting part of the head.
  4. Cephalhematoma—is a collection of blood between the periosteum of the skull bone and the bone itself caused by rupture of the periosteum capillary due to the pressure of birth.
  5. Craniotabes—is a localized softening of the cranial bones.
4. Eyes—vision is present as evidence of blinking reflex
5. Ears—hearing is present as soon as amniotic fluid is drained or is absorbed from the middle ear.
6. Nose—may appear large for the face.
7. Mouth—should open evenly when the baby cries.
8. Neck—is short and chubby, creased with skin folds and head rotate freely.
9. Chest—appear small in proportion to infant’s head.
  1. Abdomen—contour is slightly protuberant (sticking out from the surroundings)
  2. Anogenital Area—anus should not be covered by a membrane. Take note of the time meconium is first passed.
    1. Back—the spine appears flat in the lumbar and sacral areas
    2. Extremities
      1. Arms and legs appear short
      2. Hands are plump and clinch into fists
      3. Should move symmetrically
      4. Fingernails are soft, smooth
      5. Good muscle tone, arms always in flexed position
      6. Palm of hands should have three creases.
      7. Legs are bowed as well short
      8. Soles of the feet appears to be flat
      9. Presence of crisscrossed lines on the soles of the foot.
    3. Feeding

Provide Discharge Instructions

  1. Breast-fed babies are fed immediately after birth and can be fed on demand or at least every 2 hours for the first few days of life. Advice to alternate both breast at 10-15 minutes each.
  2. Bottle-fed babies routinely received an initial feeding of about 1oz of sterile water at 4-6 hours of age to be certain the infant can swallow without gagging and aspirating. The newborn is then fed every four hours.
    1. Sleep patterns—newborns sleep 16-20 hours a day
    2. Bathing—may be given anytime convenient as long as it is not within 30 minutes after feeding as handling might cause regurgitation. Sponge baths are done until cord falls off.
  3. Cord Care
    1. Dab rubbing alcohol (70% sol’n) two or three times a day for faster drying.
    2. Fold down diapers so that cord does not get wet during voiding.
    3. Small, pink granulating area may be seen on the day the cord falls off. If it remains moist or with foul discharge, advise mother to bring baby to the doctor’s clinic.
  4. Car Safety. Until a child reaches a weight of 20lbs, the best type of car seat is an “infant only” seat that faces the back of the car.


Pillitteri, A. (2007). Maternal and Child Health Nursing:Care of the Childbearing and Childrearing Family. Winsconsin: Lippincott Williams & Wilkins.